Introduction: Little is known about intentions to use Food and Drug Administration-authorized e-cigarettes (FAEs) among U.S. adults who smoke cigarettes despite initial product authorizations and ongoing reviews. This study examined such intentions in this population.

Methods: We conducted an online survey in 2024 with adults who smoke cigarettes (n=2,612; ages 21-70) in the U.S. using a national panel. Participants read a description of FAEs and then answered related questions. We assessed the weighted prevalence of intentions to use FAEs (in general and for quitting) and used bivariate and multivariable ordinal logistic regressions to examine associations between sociodemographic, tobacco use behaviors, and FAE use intentions.

Results: Over half of the participants reported being "somewhat," "very," or "extremely" interested in using FAEs in general (53%) and to quit smoking (53%). The multivariable regressions showed participants who reported their subjective financial situation as "do not meet basic needs" or had a high school degree or less had lower FAE use intentions than those who reported they "live comfortably" or had higher education, respectively. Those with plans to quit smoking or who had used e-cigarettes and FAEs before reported increased FAE use intentions than those who had no plans to quit and had never used those products before, respectively.

Conclusions: FAEs may appeal to more than half of adults who smoke cigarettes, though people with lower socioeconomic statuses or no plans to quit reported lower FAE use intentions. This study can inform policy and communication strategies related to e-cigarette authorization in the U.S.

Implications: This study is among the first nationally representative surveys among U.S. adults who smoke cigarettes to examine the prevalence of intentions to use FDA-authorized e-cigarettes (FAEs), both in general and for smoking cessation, and the socioeconomic and tobacco use-related factors associated with these intentions. The study found that FAEs may appeal to more than half of adults who smoke, though people with lower socioeconomic statuses or no plans to quit smoking reported reduced FAE use intentions. This study can inform policy and communication strategies related to e-cigarette authorization in the U.S.

Introduction: Controversy remains regarding whether nicotine vaping products (NVPs) are associated with cigarette cessation in observational research. Reviews have largely overlooked studies using the same data source. To address this gap, we conducted a narrative review to examine the heterogeneity in the reported association that used data from the same source, which may help to explain inconsistent findings.

Methods: We identified empirical studies through PubMed and Google searches that exclusively used the Population Assessment of Tobacco and Health (PATH) Study data to examine associations between NVP use and smoking cessation among adults. Adapting Arksey and O'Malley's approach, we extracted and summarized key study characteristics, including inclusion criteria, participant characteristics, study durations, definitions of NPV exposure and smoking outcomes, covariate adjustment, and analytic methods. We also conducted regression and regression tree analyses to examine how these characteristics were related to study findings.

Results: We identified 28 articles comprising 38 analyses of NVP use and cigarette cessation. Of these, 24 studies (63.2%) reported a positive association, concluding that NVP use predicted cessation. Substantial heterogeneity existed across study characteristics. Evidence suggests that daily NVP use may promote cessation, whereas studies restricted to participants with an intention to quit were less likely to observe cessation than those including participants regardless of quit intention.

Conclusions: Researchers are advised against making broad claims based on any single PATH Study analysis of NVP use and smoking cessation. Rather, multiple studies using the same data source must be carefully examined in order to synthesize evidence and assess consistency of the findings.

Implications: Whether NVPs help adult smokers quit remains controversial in observational research, partly due to heterogeneity in study characteristics across studies using the same data source. Our review of observational studies based exclusively on a single data source-an approach often overlooked-suggests that (1) daily NVP use may support smoking cessation, and (2) studies that restricted participants to those with an intention to quit were less likely to observe cessation than studies that included participants regardless of quit intention. These findings underscore the value of multiple analyses using the same data source to synthesize evidence and assess consistency.

Objective: Electronic nicotine delivery systems (ENDS), such as e-cigarettes, have surged in popularity. While long-term risks remain unclear, known dangers include nicotine addiction, E-cigarette or Vaping Use-Associated Lung Injury and potential extrapulmonary effects on the heart, immune system and neurodevelopment. Addressing ENDS addiction may require strategies akin to smoking cessation. However, evidence is lacking; there are no currently approved vaping-cessation aids. The objective of this review is to summarise the available literature addressing interventions for vaping cessation.

Data sources and study selection: A librarian-assisted search was conducted in MEDLINE, Embase and Scopus, as well as preprints in Europe PMC, Open Science Framework, and the grey literature searches until January 2024. Six included studies used self-report methods to determine the abstinence rate, while one study used cotinine-level-verified self-reported abstinence. We included randomised controlled trials (RCTs) that examine 'rates of vaping cessation' outcomes. An intention-to-treat approach was used for data extraction, and random-effects meta-analyses models were applied.

Data synthesis: Seven RCTs were included, which studied pharmacological therapy, digital interventions and/or educational content. The primary meta-analyses demonstrated a statistically significant increase in the odds of achieving 7-day point prevalence abstinence (PPA) (OR 1.52, 95% CI 1.15 to 2.01, number of participants=3244, moderate-certainty) and continuous abstinence (OR 2.71, 95% CI 1.31 to 5.61, number of participants=164, low-certainty) following intervention. A non-significant increase in odds was noted at 30-day PPA (OR 1.32, 95% CI 0.72 to 2.42, number of participants=1994, very low certainty).

Conclusions: Vaping cessation interventions increase 7-day PPA rates at 1-12 months follow-up and this was consistent across prespecified subgroup analyses of the intervention type, outcome and duration of follow-up. More high-quality studies with reproducible findings are needed to enhance the certainty of the evidence and guide clinical interventions.

Prospero registration number: CRD42022383670.

Background: This study considers recent trends in combustible and e-cigarette use among US young adults who smoked cigarettes in adolescence, who are the originating source of most adults who smoke.

Methods: Data come from the Monitoring the Future study, which includes young adults aged 19-30 who were first surveyed in 12th grade as part of a nationally-representative sample. The analysis centres on 3623 observations from 2377 young adults surveyed from 2017 to 2022 who reported they had ever smoked a combustible cigarette in the initial, 12th grade survey.

Results: Among young adults who had smoked in adolescence, the percentage who used a combustible cigarette currently (in the past 30 days) significantly declined from 45% in 2017-2018 to 35% in 2021-2022. The percentage who currently used nicotine hovered around 50%, as measured by current use of an e-cigarette or combustible cigarette and this percentage did not significantly trend over the study period. The percentage who currently used e-cigarettes exclusively and not combustible cigarettes tripled from 6% in 2017-2018 to 21% in 2021-2022. About half of this exclusive e-cigarette group deliberately used e-cigarettes to quit combustible cigarettes, in all years. Dual use of both e-cigarettes and combustible cigarettes significantly increased from 11% in 2017-2018 to 17% in 2021-2022. Trends were robust in multivariable regression analyses that controlled demographics.

Conclusion: Among young adults who had smoked in adolescence, a 10-point decline in cigarette prevalence from 2017 to 2022 coincided with a 7-point increase in the percentage who deliberately used e-cigarettes to quit combustible cigarettes.

Introduction: Adults with low-income (LI) are more likely to smoke. Alternative Nicotine Delivery Systems (ANDS) like electronic cigarettes (EC) and oral nicotine pouches (ONP) are less harmful options that may help reduce the use, and ultimately risk, of combustible cigarettes (CC). This study examined facilitators and barriers to switching from CC to either EC or ONP among LI adults who smoked daily, enrolled in a randomized controlled trial.

Methods: Thematic analysis of semi-structured one-on-one interviews with experimental group participants (n = 26) was implemented to identify themes related to the facilitators and barriers to switching from CC to EC or ONP.

Results: Facilitators of switching to EC and ONP were the convenience of using these products in public and private spaces, their effectiveness at satisfying cravings for nicotine, and the perceived belief that ANDS are less harmful than CC. Barriers to switching to ANDS included delayed nicotine delivery, preferring the sensory experience of smoking to ANDS, and limited knowledge and misconceptions about ONP compared to EC.

Conclusion: Participants indicated that both EC and ONP helped them cut down on CC use due to their convenience and ability to satisfy nicotine cravings. However, while participants believed that ANDS are less harmful than CC, more information is needed, specifically on the safety of ONP.

Implications: This study presents compelling evidence that ANDS products are acceptable among LI populations who smoke, suggesting they could be used for reducing health disparities and mortality. However, public health education and messaging regarding ONP may be needed to facilitate switching.

Background: There is no published evidence to support the efficacy of any digital vaping cessation program for young adults (YAs) at differing levels of readiness to quit. In this pilot randomized controlled trial, we evaluated the preliminary acceptability and efficacy of a program for vaping cessation based on acceptance and commitment therapy (ACT on Vaping), delivered via a smartphone app and text messaging.

Methods: YAs aged 18-30 (n = 61) were randomized 1:1 to ACT on Vaping (n = 31) or incentivized text message control (n = 30). Outcome data were collected at 3 months post-randomization. Results were compared against a priori benchmarks for acceptability (satisfaction of ≥3.5 on 5-point scale) and efficacy relative to control (meeting at least one of three): ≥1-point difference in Contemplation Ladder change scores; ≥5 percentage difference in 24-hour quit attempts, ≥5 percentage difference in cotinine-confirmed 30-day point prevalence abstinence (PPA) from all non-therapeutic nicotine/tobacco.

Results: Satisfaction with ACT on Vaping averaged 3.8, exceeding the acceptability benchmark. A higher proportion of participants in the ACT on Vaping arm reported a 24-hour quit attempt (87.5% vs. 75.9%), exceeding the efficacy benchmark. Both changes in quit readiness (+0.96 in ACT on Vaping vs. +0.72 in control) and cotinine-confirmed 30-day PPA (4.2% in ACT on Vaping vs. 0% in control) were descriptively higher for ACT on Vaping but did not reach the benchmark level for efficacy.

Conclusions: ACT on Vaping had promising acceptability and preliminary efficacy. A fully powered trial of ACT on Vaping is warranted to evaluate its efficacy.

Implications: Digital interventions are a promising yet under-researched approach for reaching and supporting YAs to quit vaping. This proof-of-concept pilot randomized controlled trial evaluated a novel mobile health application and associated text messaging program (ACT on Vaping) for young adult vaping cessation and found preliminary evidence for acceptability and efficacy relative to an incentivized text message control arm, warranting evaluation in a fully powered trial as a next step.

Trial registration: NCT05897242.

Indigenous Peoples experience disproportionately high rates of commercial tobacco use and smoking-related illness. Although pharmacotherapies are effective in the general population, their effectiveness among Indigenous communities remains uncertain. This systematic review synthesized randomized controlled trials (RCTs) evaluating pharmacotherapies for smoking cessation among Indigenous adults. 

Methods: MEDLINE, Embase, CENTRAL, APA PsycINFO, Informit Indigenous Collection, Bibliography of Indigenous Peoples in North America, and Global Health were searched in June-September 2024, with an update of all but Informit on May 28, 2025. Eligible studies were RCTs assessing pharmacotherapies, alone or combined with behavioral or culturally tailored supports for smoking cessation among Indigenous adults. Due to heterogeneity, findings were synthesized narratively. 

Results: Five RCTs (n = 1633 participants) from American Indian, Alaska Native, and Māori populations incorporating nicotine replacement therapy, bupropion, varenicline, and cytisine met inclusion criteria. At six months, self-reported 7-day point-prevalence abstinence ranged from 12.0% to 41.4% and biochemically verified abstinence from 6.9% to 22.6%. Adherence was generally high, and adverse events were mild. 

Conclusions: Limited but suggestive evidence indicates that pharmacotherapies, particularly when paired with supportive or culturally tailored interventions, may aid smoking cessation among Indigenous adults. Interpretation is constrained by heterogeneity and high attrition. Further community-led, culturally grounded RCTs are needed.

Despite longstanding evidence of the disproportionate burden menthol cigarettes pose to Black Americans, the U.S. Food and Drug Administration's (FDA) proposed federal ban has faced consistent delays. Menthol is associated with an increased risk of addiction, fewer quit attempts, and disproportionate rates of smoking-related illness and death among Black Americans. While states like Massachusetts and California have taken steps to implement bans, the U.S. federal government has yet to act. These delays are a public health failure that perpetuates racial health disparities. This paper explores the historical targeting of Black communities by the tobacco industry and highlights the complex responses to the potential ban from those in Black communities. Despite mixed public opinion, the evidence is clear that a federal menthol ban, combined with equitable culturally tailored cessation resources, can save lives and address disproportionate tobacco-related health disparities.

In the United States certain groups, such as African Americans (AA) and sexual minorities (SM) have disproportionately high rates of flavored tobacco use. Policies restricting flavored tobacco may especially benefit these groups and lead to an equitable reduction in tobacco use. This study used Behavioral Risk Factor Surveillance System data from Massachusetts and Connecticut (control state) to evaluate changes in cigarette use before and after Massachusetts' flavor restriction policy was implemented. Difference-in-difference (DID) was used to evaluate the overall impact and difference-in-difference-in-difference (DDD) was used to evaluate the impact on AAs and SMs. There were no significant differences in the change in cigarette use for adults overall or for AA adults in Massachusetts compared to Connecticut. Among SMs, Connecticut had a greater decrease in cigarette use compared to Massachusetts. As more data become available, it will be crucial to monitor the longer-term impact of the policy and any differences in policy impact among groups.

Introduction: Cigarette smoking and other forms of commercial tobacco use remain disproportionately high among American Indian communities compared with the general U.S. population. Mainstream tobacco control strategies often have limited success in Tribal contexts, underscoring the need for culturally grounded interventions.

Methods: We conducted 30 key informant interviews with program staff and Tribal community members from 11 California Tribes participating in the California American Indian Tobacco Initiative. Interviews were conducted at two time points, transcribed, and analyzed using descriptive and evaluation coding to assess the implementation, perceived impact, and challenges of core tobacco control objectives.

Results: All 11 programs successfully engaged youth through coalitions and education activities. Nine programs implemented smoke-free household efforts with mixed but generally positive uptake of voluntary pledges. Five programs implemented tobacco product waste initiatives that increased awareness of environmental harms and mobilized community clean-up events, and four pursued excise tax strategies, with questions about revenue allocation emerging as a key challenge. Across objectives, culturally relevant, community-driven approaches were seen as critical to success.

Conclusions: Tribal-led interventions including youth coalitions, smoke-free household pledges, and tobacco waste campaigns show promise for reducing commercial tobacco harms in California American Indian communities, though policy and implementation barriers remain and warrant ongoing attention.

Background: As nicotine pouches are increasingly adopted as a harm reduction method for tobacco cessation, it is important to understand who incorporates nicotine pouches into cessation attempts. This preliminary study examined correlates of nicotine pouch use for tobacco cessation in a United States (US) nationally representative sample.

Methods: Data were from Wave 7 (2022-2023) of the US Population Assessment of Tobacco and Health Study. Outcomes were past-12-month use of nicotine pouches to quit cigarettes or other non-electronic nicotine delivery system (ENDS) and other nicotine/tobacco products (N = 3622) and to quit ENDS (N = 1934). Predictor variables included sociodemographic, psychological, and behavioral factors.

Results: Ninety individuals reported using nicotine pouches during their most recent quit attempt for non-ENDS products, while 65 individuals reported use during the quit attempt for ENDS. Multivariable regression analyses showed that males were significantly more likely to use nicotine pouches to quit non-ENDS and ENDS (Adjusted Prevalence Ratio [APR] = 2.00, 95% Confidence Interval [CI] = 1.19, 3.37; APR = 6.28, 95% CI = 2.77, 14.25). Having used other methods to quit other nicotine/tobacco products was associated with higher likelihoods of having used nicotine pouches to quit non-ENDS (APR = 2.43, 95% CI = 1.48, 4.01) and ENDS (APR = 1.95, 95% CI = 1.05, 3.61). Having used nicotine pouches to quit non-ENDS was less likely to be reported by Black individuals (APR = 0.31, 95% CI = 0.11, 0.88).

Conclusions: This preliminary study observed positive associations of male gender and use of other cessation methods and a negative association of Black race with having used nicotine pouches to quit other nicotine/tobacco product use.

Implications: In a national United States sample, having used nicotine pouches to quit other nicotine/tobacco product use was more likely to be associated with being male and using other nicotine/tobacco product use cessation methods, but less likely to be associated with Black race. Ongoing surveillance and research examining the health effects of nicotine pouch use is warranted, particularly regarding sex and racial/ethnic differences in nicotine pouch use as a harm reduction approach for other nicotine/tobacco product use cessation.

Introduction: Sexual and gender minority youth are at higher risk for nicotine/tobacco use than cisgender and/or heterosexual youth. Little is known about how the use of multiple tobacco/nicotine products differs among youth by sexual orientation and gender identity. This study sought to determine whether the lifetime number of tobacco/nicotine products differs by sexual orientation and gender identity.

Methods: This study is a cross-sectional analysis of nationally representative data on 14 457 students ages 9-19+ who participated in the 2023 National Youth Tobacco Survey. Weighted means, adjusted odds ratios, and adjusted incidence rate ratios were used to assess differences in the number of lifetime tobacco/nicotine products used by students in the following groups: cisgender heterosexual; cisgender sexual minority; gender minority heterosexual; and gender and sexual minority youth.

Results: Adjusting for age, race/ethnicity, and sex, gender minority heterosexual youth used more than twice as many tobacco/nicotine products as their cisgender heterosexual peers, with an adjusted incidence rate ratio (aIRR) of 2.47; 95% confidence interval (CI), 1.10-5.56; p=.030. Gender and sexual minority youth also used twice as many methods as their cisgender heterosexual peers (aIRR, 2.05; 95% CI, 1.40-2.98; p<.001).

Conclusion: Among youth aged 9-19+ years, gender minority youth of any sexual orientation used a higher lifetime number of tobacco/nicotine products than did cisgender heterosexual youth. Prevention, harm reduction, and cessation programs for youth are needed to respond to the upward trend of multiple tobacco product use among youth and the specific needs of gender minority youth.

Objective: Strategies are needed to increase adolescent and young adult (AYA) engagement in nicotine use treatment. We assessed feasibility, acceptability, and clinical impact of text-message outreach connecting AYA to nicotine use treatment across a large health network.

Methods: This quality improvement pilot study included two phases of text-message outreach following primary care visits. All patients aged 13-22 completed an in-visit confidential electronic health questionnaire assessing past 30-day nicotine use. Phase 1: patients selected whether to receive text outreach about quitting resources. Phase 2: all patients reporting nicotine use who provided a phone number on the electronic questionnaire received automatic text outreach. Treatment options included a text-messaging program (This is Quitting) and/or nicotine replacement therapy. Outcome measures included feasibility (phone number provision), acceptability (treatment interest), and clinical impact (treatment connection).

Results: Among 23,411 AYA screened February-June 2024, 919 (3.9%) reported past 30-day nicotine use. For feasibility, 90% and 91% of AYA who reported nicotine use provided a phone number in each phase, respectively. Acceptability was higher in Phase 1 versus Phase 2 (11% vs. 2%), but clinical impact was similar (2% vs. 1%). Overall, 824 patients who reported nicotine use provided a phone number (90%), 59 expressed treatment interest (6%), and 16 connected to treatment (2%).

Conclusions: Text-message outreach was feasible but achieved low acceptability and clinical impact. Barriers included a high rate of messages blocked as spam, limited interventions for AYA with infrequent nicotine use, and barriers to accessing NRT related to cost and confidentiality.

Objectives: To examine the temporal trends of current cannabis use only, tobacco use only, and co-use of these two substances by racial and ethnic adolescent groups.

Methods: Data were drawn from the 1991-2021 Youth Risk Behavior Surveys (YRBS) (n = 234,572) to examine changes in cannabis and tobacco use among American Indian or Alaskan Native (AI/AN), Asian, Black, Hispanic/Latino (H/L), Native Hawaiian or other Pacific Islander only (NH/PI), White, and multi-racial high school students. Multivariable logistic regressions were performed to examine racial and ethnic disparities in current cannabis and tobacco use across four equal interval periods (i.e., 1991-1997, 1999-2005, 2007-2013, 2015-2021).

Results: During 2015-2021, Black (12.6% (95% CI11.3-13.9%)), H/L (9.0% (7.9-10.1%)), and multi-racial (8.8% (7.3-10.3%)) adolescent reported higher prevalences of cannabis-only use than whites (4.9% (4.4-5.5%)), while AI/AN (20.1% (15.1-25.2%)) reported higher prevalence of tobacco and cannabis co-use than whites (13.4% (12.2-14.5%)). The prevalence of cannabis-only use was highest among Black adolescents and increased from 10.8% (9.3-12.2%) in 1991-1997 to 12.6% (11.3-13.9%) in 2015-2021 (linear trend, p = .004), while AI/AN adolescents maintained the highest prevalences of cannabis and tobacco co-use across last three decades (p = .17) with 23.0% (16.6-29.4%) in 1991-1997 to 20.1% (15.1-25.2%) in 2015-2021. As compared to their White counterparts, Black and H/L adolescents consistently exhibited higher prevalences of reporting cannabis-only use, but lower tobacco-only use; AI/AN adolescents had higher cannabis-tobacco co-use and Asian adolescents reported lower cannabis and tobacco use.

Conclusions: These disparities highlight the importance of public health programs addressing diverse substance use behaviors across racial and ethnic groups. There is a need for early prevention and tailored interventions to reduce cannabis-only use among Black adolescents and tobacco-cannabis co-use among American Indian/Alaskan Native adolescents.

Introduction: Understanding which theories have been effectively applied in tobacco control efforts for sexual and gender minority (SGM) individuals will help identify constructs to incorporate into future tobacco control efforts aimed at reducing SGM tobacco disparities. This scoping review summarizes the use of theory in SGM-focused tobacco control efforts.

Methods: We searched four databases using SGM- and tobacco-focused terms in November 2023. Two trained coders independently screened each title and abstract, reviewed the full text, and extracted data about theories used and which tobacco control measures from the World Health Organization Framework Convention on Tobacco Control were included.

Results: The final analytic sample included 86 papers. Of those, 11 (12.9%) discussed price/tax manipulations, 15 (17.7%) discussed secondhand smoke and smoke-free policies, 11 (12.9%) discussed product characteristics (e.g., flavors), 5 (5.9%) discussed product disclosures (e.g., warning labels), 7 (8.1%) discussed packaging, 23 (27.1%) discussed education, communication and public awareness, 15 (17.7%) discussed tobacco advertising and promotion, 49 (57.7%) discussed tobacco prevention/cessation interventions, and 1 discussed Tobacco 21 (1%). Under half (31 articles, 36.0%) explicitly presented theoretical models.

Conclusions: This review found a relative lack of theoretical models applied in tobacco control initiatives for SGM people. Of the 31 studies that did, most used theory to help clarify the etiology and associated factors of tobacco use (e.g., minority stress, increased exposure to marketing) or tailor prevention/cessation interventions focused on SGM individuals. Future studies should be grounded in theory to increase the effectiveness of these activities while preventing potential unintended consequences.

Implication: This scoping review aimed to summarize which theoretical models have been implemented in relation to tobacco control measures among SGM individuals. Most theories were integrated in helping explain disparities or tailor interventions. Large-scale tobacco control initiatives may cause unique harm to SGM samples when critical theories are not integrated into their design and implementation.

Background: Due to the colonization of tobacco plants by European settlers and the subsequent intensive marketing of commercial tobacco products to American Indian and Alaska Native (AI/AN) communities in the United States, commercial cigarette smoking accounts for half of all deaths among AI/AN people. Limited awareness, access to treatment, and the absence of culturally relevant, effective smoking cessation interventions contribute to these high death rates.

Objective: This study aims to culturally adapt iCanQuit, a smartphone smoking cessation app proven efficacious for the general population, for AI/AN people.

Methods: A user-centered and community-based participatory research (CBPR) mixed methods approach was applied to culturally adapt iCanQuit for AI/AN people in collaboration with a community advisory board (CAB) of AI/AN individuals using a 3-step process. Step 1 identified ways to culturally adapt the iCanQuit for AI/AN people through 1-on-1 qualitative interviews with 8 prior iCanQuit AI/AN participants. Step 2 involved developing prototypes of cultural refinements identified in step 1 through regular biweekly meetings of the CAB, research, and app development teams. The prototypes were then evaluated with a separate group of 4 prior iCanQuit AI/AN participants through 1-on-1 qualitative interviews. Step 3 involved beta testing the app through a 6-day diary study followed by 1-on-1 qualitative interviews with a nationally recruited group of 7 AI/AN adults who smoke commercial cigarettes. The development work associated with step 3 was further informed by the CAB and the research and app development teams.

Results: Key findings identified 5 cultural refinements that informed subsequent app development and testing: (1) stories featuring AI/AN adults and elders emphasizing culture, spirituality, family, and community; (2) honoring the Earth as a motivator for cessation; (3) a guide character representative of AI/AN people; (4) clear distinction between ceremonial and commercial tobacco use; and (5) use of earth tones in visual design. In Step 3, all 7 (100%) diary study participants rated the beta version of the app as excellent or good/meets expectations (5/7, 71%, and 2/7, 29%, respectively) and that it felt made for them. They suggested 6 modifications which were incorporated into the final version of the app: (1) include vaping frequently asked questions, (2) feature motivation icons more prominently, (3) increase notification frequency, (4) track today's cigarettes rather than yesterday's, (5) allow users to update how much they spend per pack of cigarettes; and (6) rename the medications tool to reflect the inclusion of AI/AN traditional healing modalities.

Conclusions: A user-centered and CBPR development process yielded IndigeQuit-one of the first known apps developed specifically to help AI/AN adults quit commercial cigarette smoking.

Trial registration: ClinicalTrials.gov NCT06145763; https://clinicaltrials.gov/ct2/show/NCT06145763.

Significance: Understanding how integrated tobacco tax policies influence purchasing decisions across socioeconomic groups is critical to advancing tobacco control in an equitable manner in the context of the rapidly evolving tobacco and nicotine product market. Using an Experimental Tobacco Marketplace (ETM), this study examined the effects of four multitiered tax policies on tobacco purchasing among people who smoke cigarettes. Each policy used a different strategy to attain the goal of reducing cigarette purchasing among three socioeconomic groups. The policies were: tobacco parity, nicotine content, harm reduction and modified risk tobacco products.

Methods: A sample representative of the US population (N=481) was recruited from a national survey panel (Prolific). Using a within-subject/between-subject factorial design, participants completed hypothetical purchasing trials in the ETM with products priced under the four multitiered tax policies. Higher tiers equated to higher taxes.

Results: Higher taxes consistently reduced relative spending, while relative spending on medium-tax and no-tax tier products varied by tax proposal. The nicotine content tax policy led to the largest reduction in high-tax tier spending and the greatest shift toward no-tax products (eg, nicotine replacement). No socioeconomic differences were observed.

Conclusions: These findings indicate that strategic taxation is a robust and adaptable tool for shifting tobacco purchasing. Integrated tobacco tax policies are likely to be effective at reducing consumption of the highest-risk products without a disproportionate socioeconomic impact.

Trial registration number: NCT06795997.

Introduction: Increasingly, U.S. states and localities are passing policies to restrict menthol and other characterizing flavors in tobacco products. Given the disproportionate use of flavored tobacco among historically marginalized groups, such restrictions have the potential to promote health equity. This scoping review aimed to characterize community perceptions of flavor restrictions using an equity lens.

Methods: We conducted a PubMed search for U.S.-based studies that reported on flavor restriction outcomes, disaggregated by race, ethnicity, or lesbian, gay, bisexual, transgender, and queer (LGBTQ) identity.

Results: Across the 22 studies identified, two foci emerged: factors influencing the passage of flavor restrictions (eg, policy support) and the impacts of implementing these restrictions (eg, cessation intentions). Support for flavor restrictions varied by product and population: menthol cigarette restrictions received notably higher support among African American and Hispanic communities, while evidence for e-cigarette flavor restrictions was mixed-some studies reported minimal subgroup differences, whereas others reported higher support among specific racial/ethnic groups. A few studies discussed unintended consequences, such as product substitution or engagement with illicit channels; these studies were also mixed regarding which racial/ethnic groups would be most impacted. Key research gaps included long-term behavioral outcomes and outcomes across LGBTQ identities.

Conclusions: While there are clear racial/ethnic differences for support of menthol cigarette bans, much of the literature on other types of flavor restrictions is mixed. Further research is needed to resolve these discrepancies and expand beyond race and ethnicity when disaggregating subgroups. Such efforts are critical to ensuring flavor restrictions achieve their intended public health benefits and advance health equity.

Introduction: The purpose of this study was to characterize the dose-response relationship between duration of cognitive-behavioral counseling and abstinence in individuals who participated in a randomized controlled trial for smoking cessation.

Methods: This is a secondary analysis of participants enrolled in double-blind randomized controlled trials for smoking cessation consisting of 12 weeks of pharmacotherapy (placebo; N = 142; varenicline; N = 257) combined with counseling. Participants were 41% female, 66% non-Hispanic White, who smoked a median of 20 cigarettes per day. Seven-day point prevalence (7-dayPP) and prolonged abstinence were calculated at the end of treatment and at the 6-month follow-up.

Results: All abstinence outcomes exhibited sigmoidal (s-shaped) relationships with duration of counseling, and the median effective duration was similar (ranging from 130 to 160 min). The sigmoidal curves between placebo and varenicline were significantly different (7-dayPP at end of treatment; EOT: F = 14.68, p < .01) The difference between the maximum efficacy for the medications is 0.34 (p-value < 0.01) for 7-dayPP abstinence at EOT, indicating ~35% higher rates of abstinence at the maximum efficacy of counseling for those in the varenicline group as compared with those in the placebo group.

Conclusions: Participants who received counseling and pharmacotherapy to quit smoking exhibited a duration-dependent response of abstinence to counseling captured by a sigmoidal curve that exhibited variation in the maximum efficacy between placebo and varenicline, suggesting either that counseling for smoking cessation enhanced the effect of varenicline on abstinence, or more likely, that counseling was more effective in achieving abstinence in the presence of varenicline.

Implications: The results suggest that cognitive-behavioral counseling for smoking cessation is more effective in achieving abstinence in the presence of varenicline or less likely, that counseling enhanced the effect of varenicline on abstinence. Optimizing the duration of counseling, particularly when coupled with pharmacotherapy, can offer more tailored and efficient cessation strategies. This finding emphasizes that the integration of behavioral and pharmacological approaches is crucial for maximizing the effectiveness of smoking cessation interventions, consistent with previous evidence and current guidelines.

Introduction: Cigarette smoking is the world's leading preventable cause of death. With no new smoking cessation pharmacotherapy approved since 2006, the 29 million US adults who smoke need new treatment options. Cytisinicline, a partial agonist at α4β2 neuronal nicotinic acetylcholine receptors, is the name of a new dosing regimen of cytisine, a smoking cessation pharmacotherapy that has been sold for decades in Eastern Europe but is currently unavailable in the US. The Food and Drug Administration is evaluating a New Drug Application for cytisinicline.

Areas covered: We summarize the history, chemistry, pharmacodynamics, and pharmacokinetics of cytisine and cytisinicline and explain their different dosing regimens. Two Phase 3 randomized double-blind placebo-controlled trials have demonstrated cytisinicline's efficacy and safety for smoking cessation in US adults. We review the trial results in the context of previous evidence supporting cytisine and other cessation medications.

Expert opinion: Cytisinicline has a strong evidence base to support US licensure as a smoking cessation aid. If approved and its effectiveness in clinical practice confirms its clinical trial efficacy, cytisinicline will likely join varenicline and combination nicotine replacement as a first-line smoking cessation treatment option. It may also aid cessation of electronic-cigarette vaping or other nicotine-mediated dependence disorders.

Background: Although mobile health (mHealth) apps for tobacco cessation augment traditional cessation methods and have contributed to increases in cessation rates, Black adults are underrepresented in mHealth app studies for tobacco cessation. As a result, their mHealth app preferences are not well-known.

Objective: Our goal was to identify features of mHealth apps for cessation that are important to Black adults who use tobacco products.

Methods: We developed an online discrete choice experiment with 12 pairs of hypothetical mHealth apps for tobacco cessation. Inclusion criteria included being 21 years or older, current use of any tobacco product, and identifying as Black or African American. Participants had to be interested in tobacco cessation and have a history of mHealth app use or be willing to use one in the future. From each pair of hypothetical apps within the survey, participants had to choose the app they preferred. Each hypothetical app was made up of 7 features developed from existing mHealth literature and prior qualitative work: graphics, marketing, strategies for quitting, connection with others, personalization, benefits of quitting, and health information. Each feature had up to 4-5 levels (ie, variations of that attribute), and each hypothetical mHealth app was comprised of a random assortment of levels of features. Hierarchical Bayes estimation was used to determine the part-worth utility for each level within each feature for each participant, which was then used to calculate the importance score. Average importance scores across respondents were used to determine overall importance scores for each feature.

Results: We had 901 adult participants. The mean age was 41 (SD 14.02) years, and about a third of participants (377/901, 42%) were female. Two-thirds of participants (549/901, 61%) had used an mHealth app in the past, and the great majority (786/901, 87%) indicated a willingness to use an app for health purposes in the future. The features had the following importance: graphics (16%), marketing (15%), strategies for quitting (15%), connection with others (14%), personalization (13%), benefits of quitting (13%), and health information (13%). Within features, strategies for quitting had the highest and third-highest levels of "making a step-by-step quit plan" and "recommendations to manage relapse or withdrawal," respectively. Marketing had the second-highest level of "Historically Black Colleges and Universities-endorsed app." Graphics had the fourth-highest level of "short video testimonials from people who successfully quit," while connection with others had the fifth-highest level of "quit buddy program for support and accountability."

Conclusions: This study identified features of mHealth apps important to Black adult tobacco users. To enhance the appeal of mHealth apps to such adults, prioritizing inclusion of highly preferred levels in apps may lead to higher use and improved cessation.

Objectives: Some e-cigarette brands have begun offering "boost" modes (aka "pulse" or "turbo"). Our objectives were to (1) Determine the prevalence of boost mode utilisation among adolescents and young adults (AYAs) and (2) Identify the personal and tobacco-use characteristics of AYAs who use boost mode.

Design: Cross-sectional survey from January to July 2025.

Subjects: n=267 AYAs (M age=21.4, SD=2.3, range 14-25) who lived in the US and had used an e-cigarette at least once within the last 30 days. All participants completed a video conference call with study staff before being sent the online survey.

Main outcome measures: AYAs were asked: "Does the e-cigarette or vaping device that you use most often have a "boost" or "pulse" function?". Those who responded "yes" were asked, "How often do you use the "boost" or "pulse" function?".

Results: 55.1% of participants had a device with boost mode. Of these, 54.4% used it "just now and then" or "sometimes", and 27.9% used it "very often" or "always". Participants whose device had (vs did not have) a boost mode were younger, had lower socioeconomic status, used their e-cigarette more frequently (every day or almost every day) and had higher scores on the E-cigarette Dependence Scale. There were no differences by Hooked on Nicotine Checklist score, gender, race and ethnicity or use of other tobacco products.

Conclusion: If, as brands claim, boost modes alter e-cigarette aerosol production, they likely have implications for AYA nicotine addiction and health effects. Longitudinal and laboratory investigations on boost modes are urgently needed.

Objective: Electronic nicotine delivery systems (ENDS) have seen a global surge in their usage. However, their role in smoking initiation, particularly among non-smokers, remains a critical concern. This umbrella review evaluated the risk of tobacco-smoking initiation following ENDS use, focusing on non-smokers, by synthesising evidence using Bayesian meta-analysis.

Study design: Systematic review and Bayesian meta-analysis.

Methods: We searched databases including PubMed, EMBASE and Cochrane Library up to 1 May 2025. We included systematic reviews assessing tobacco-smoking initiation after ENDS use among non-smokers. Quality was evaluated using the AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews - version 2). A Bayesian hierarchical meta-analysis was conducted to estimate pooled ORs with 95% credibility intervals (CrIs), using non-informative priors to model heterogeneity and uncertainty. This study was registered with PROSPERO (CRD42023464207).

Results: From 5055 records, 13 systematic reviews were included. Of them, five were rated as 'high quality', one as 'moderate', four as 'low' and 'three' as critically low, as per AMSTAR-2 quality assessment. The meta-analysis revealed a pooled median OR of 3.1 (95% CrI 2.56 to 3.72) for smoking initiation among non-smoking ENDS users, with moderate heterogeneity (τ mean: 1.23). Among adolescents, the OR was 2.7 (95% CrI 2.27 to 3.21), with moderate heterogeneity (τ mean: 0.63). The risk of relapse in former tobacco smokers who used ENDS was doubled (RR: 2.03, 95% CI 1.39 to 2.96). Individuals who had never smoked but engaged with ENDS had more than twice the odds of developing an intention to smoke, with an OR of 2.21 (95% CI 1.86 to 2.61). The overall certainty of the evidence was rated very low due to the risk of bias in the studies and evidence of publication bias across the studies.

Conclusions: ENDS use is significantly associated with increased risk of tobacco smoking initiation among non-smokers, particularly adolescents, supporting the gateway hypothesis. These findings indicate the need for stringent regulatory and public health strategies to protect people from nicotine addiction.

Purpose: California's longstanding, comprehensive tobacco control program includes the school-based Tobacco-Use Prevention Education (TUPE) program. Following passage of Proposition 56 in 2016, TUPE was expanded. This study investigated whether exposure to TUPE programming after Proposition 56 was associated with decreased youth tobacco use.

Methods: Data from the 2019-2020 California Student Tobacco Survey, a state-representative survey of students in grades 8, 10, and 12, were used. The survey was conducted in 358 schools. A total of 160,106 students (49,244 from TUPE-funded schools and 110,862 from non-TUPE-funded schools) were included in this study. The association of TUPE programming with student tobacco use was examined using logistic regression, controlling for the effects of personal and school variables.

Results: Students from TUPE and non-TUPE schools had similar rates of exposure to tobacco-related advertising, whether promoting vaping (16.4% vs. 16.8%, respectively), discouraging vaping (36.3% vs. 38.7%), promoting smoking (11.4% vs. 11.4%), or discouraging smoking (27.6% vs. 29.4%; all p's > 0.05). However, TUPE students were more likely to receive school-based education against tobacco use (71.0% vs. 63.8%; p < 0.001) and to participate in antitobacco activities (15.2% vs. 10.6%; p < 0.001). After controlling for the effects of personal and school variables, TUPE students were less likely to use tobacco (6.5%) than non-TUPE students (8.1%; p = 0.012).

Discussion: TUPE students were exposed to more school-based educational messaging and participated in more tobacco-related prevention activities. The greater focus on tobacco in TUPE-funded schools was associated with lower rates of tobacco use among their students.

Introduction: Although electronic cigarettes (e-cigarettes) have demonstrated efficacy for quitting combustible cigarette smoking, they also convey inherent risks. How the public views e-cigarettes and their potential harm may influence how e-cigarettes are used. We therefore evaluated perceptions of e-cigarettes over a recent 10-year period.

Methods: Longitudinal data from a multiyear cross-sectional nationally representative survey, Health Information National Trends Survey, were analyzed to assess changes in perceptions of e-cigarettes' harm relative to cigarettes and factors affecting perceptions among US adults from 2012 to 2022. We used interrupted time series regression analysis to determine possible associations with key public health events.

Results: A total of 20 771 survey respondents were included in the analysis. From 2012 to 2022, the proportion perceiving e-cigarettes as more harmful than combustible cigarettes increased from 2.8% (95% CI, 1.8%-3.9%) to 30.4% (95% CI, 28.2%-32.7%). Likewise, perceptions of e-cigarettes as less harmful decreased from 50.7% (95% CI, 47.6%-53.9%) to 16.7% (95% CI, 14.9%-18.6%). Perceptions changed significantly following the national rollout of anti-vaping campaigns (p < .001) and the e-cigarette or vaping product use-associated lung injury outbreak (p < .001).

Conclusions: Public perceptions of e-cigarettes have shifted markedly over the past decade, with increasing proportions of US adults viewing e-cigarettes as more harmful than combustible cigarettes. These changes appear closely linked to major public health events and campaigns. Understanding how such events influence perceptions is essential for guiding risk communication, public health policy, and future tobacco control strategies.

Implications: How the public views electronic cigarettes (e-cigarettes) and their potential harm may influence how e-cigarettes are used. Although e-cigarettes convey risks, they have also demonstrated efficacy for quitting combustible cigarette smoking. We found that perceptions of e-cigarettes have shifted markedly over the past decade, with increasing proportions of US adults viewing e-cigarettes as more harmful than combustible cigarettes. How such perceptions influence smoking behavior represents an important consideration for risk communication, public health policy, and tobacco control strategies. Clear, evidenced-based messaging may reduce uptake of e-cigarette use, support harm-reduction efforts for current smokers, and promote trust in public health institutions.